Provider Demographics
NPI:1508924457
Name:KANEMAKI, RANDALL TAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:TAY
Last Name:KANEMAKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 VALLEY VIEW STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620
Mailing Address - Country:US
Mailing Address - Phone:714-827-2545
Mailing Address - Fax:714-827-0506
Practice Address - Street 1:8751 VALLEY VIEW STREET
Practice Address - Street 2:SUITE B
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620
Practice Address - Country:US
Practice Address - Phone:714-827-2545
Practice Address - Fax:714-827-0506
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice